Abstract
Why doesn't Dr. Angell (June 17 issue)1 come out and say that we are going to have to deny care? It is acceptable, perhaps, to deny care when it is not needed, but the discussion of this should be public and not hidden under criticisms of the health care system and things over which it has no control. A global budget means rationing and should be discussed as rationing. I do not know how you can have competition on the basis of quality, because measuring quality is not a simple matter, and to do this for every provider physician in the United States is an expensive and massive task that will keep many bureaucrats happily employed.

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